The ever-increasing cost of prosthetic limbs

In the 1960s, the development of prosthetics, or artificial limbs, took a giant step forward. Modular limbs became available, meaning that the component parts of artificial arms and legs did not need to be manufactured individually, and only the socket interface needed to be 'bespoke'. This made life easier for prosthetists and the process cheaper for manufacturing companies, and also meant that limbs were made in a much shorter time frame, which was a positive development for amputees.

Over the next few decades, knees in particular improved, and in the 1990s, technology transfers allowed the Intelligent Knee to be produced.

In these units, a simple computer allowed knees to move at differing speeds, to allow the amputee to walk faster or slower, depending on the speeds set into the operating system. Although these knees cost slightly more than less reactive knees, the NHS was able to fund them due to the relatively low numbers of young amputees to whom it would be of benefit.

In 2000, Otto Bock, a German prosthetics manufacturer, released the now famous C-Leg. This led to a surge in prosthetic research, and microprocessor-controlled knees proliferated until we had to choose between the C-Leg, the Rheo, the Plie, and the Power Knee. The NHS could not afford to fund every patient who applied, and specialist commissioning was employed to 'justify' each rare purchase of these knees.

It is now almost exclusively the purview of the private prosthetics sector to provide limbs containing microprocessor-controlled knees.

At present day prices, a C-Leg knee costs in the region of £20,000 to £25,000.

Then, in 2012, Otto Bock released the Genium X3, which, at present day prices, costs in the region of £70,000 to £80,000.

Higher costs

The Genium X3 has been a big hit on social media platforms, and is now considered the state of the art prosthetic for above-knee amputation. As such, all personal injury and clinical negligence lawyers, and all insurance providers should be aware that all young above-knee amputees with adequate insurance will seek sufficient compensation to allow them to be supplied with a Genium X3 for the remainder of their lives.

To give an example of how these knees will affect an insurance claim for an above-knee amputee, the Genium X3 has an expected life span of seven years, so for a twenty-something victim of a road traffic accident, for just this item the insurance claim will increase by something approaching £500,000.

The same cost increases will be applied in the case of upper-limb amputation: developments in the field of robotics have revolutionised hand prosthetics, and neural implant techniques are now being applied to arms to activate small, robotic motors which can operate finger joints, thus making hands much more functional - and much more expensive.

New prosthetic devices are being developed constantly, but in the absence of any wars involving Europe or the US, the market size is unlikely to significantly increase. Until the developing world can afford such technologies, there can be no economies of scale, and so prices will not fall. All these items, together with medical advances like osseointegration, mean that insurance claims, and therefore premiums, will keep rising.

The new technology brings with it further complications. Very few people have so far been given the opportunity to see, let alone work with, these highly sophisticated items - but due to the complexity of such limbs, amputee clients need to be instructed in their safe and efficient use. This will require input from suitably trained and experienced physiotherapists. Because the NHS cannot fund these limbs, very few physiotherapists working with amputees will ever see a Genium X3, and so the private sector must be searched to find the appropriate training.

Instructing solicitors need to be sure that their expert witnesses and ultimately their clients' private prosthetic suppliers are fully conversant with these technological and medical advances, and have access to, or at least knowledge of, future developments which will inevitably lead to higher costs for the client.

RA (Shep) Shepherd BSc MCSP HCPC is a chartered physiotherapist and director of REHAB Prosthetics and Gordon Wilson Bsc (Hons) HCPC is a prosthetist/orthoptist and director of REHAB Prosthetics